Rudy Capildeo

The seasonal variation in mortality from cerebrovascular disease

The frequency distribution of deaths from cerebrovascular disease in England and Wales in 1975 by month of occurrence is described. The distribution is compared with that for related diseases, in particular ischaemic heart disease, hypertensive disease, pneumonia and bronchitis. The principal feature in all these diseases is high mortality in winter and spring and low mortality in late summer, but the range of variation is wider for pneumonia and bronchitis. The seasonal distribution of cerebrovascular disease death is similar in both sexes, all ages at death and for deaths at home and deaths in a hospital or institution. For both sexes the proportion of cerebrovascular disease deaths occurring at home increases significantly with age at death. Four hypotheses are examined to explain this characteristic seasonal mortality pattern, which is related inversely to ambient temperature, and similar to the seasonal pattern of the incidence and prevalence of cerebrovascular disease.

Sex differences in the incidence of cerebrovascular disease.

Incidence rates for cerebrovascular disease reported by community-based and hospital-based studies during the past 15 years are analysed. The range of variation between area is wide, with Japan and Finland experiencing the highest age-adjusted rates. Of 16 studies reporting incidence rates by sex, 15 showed a male excess, and nine of these were significant when the incidence rate was age-adjusted. Overall, the excess is about 30% for both community-bases and hospital-based studies. For cerebral infarction the excess is about 45%. Intracerebral haemorrhage shows little difference between the two sexes and subarachnoid haemorrhage shows a male deficit of about 50%. These findings are self-consistent.

Migraine in Patients Attending a Migraine Clinic: An Analysis by Computer of Age, Sex and Family History

SYNOPSIS

Single‐dose Pizotifen, 1.5 mg Nocte: A New Approach in the Prophylaxis of Migraine

SYNOPSIS

New classification of stroke: preliminary communication.

We describe a new method of classifying stroke using a cumulative numbering system. The method is simple and more explicit than currently used classifications, and could be useful for different agencies looking after patients with stroke in hospital or at home.

Diverging trends in cerebrovascular disease and ischaemic heart disease mortality.

The trends in age adjusted and age and sex specific mortality rates for the period 1968–1980 are compared for ischaemic heart disease and cerebrovascular disease. For both sexes and at all ages over 45 the mortality rates for cerebrovascular disease have fallen significantly. However, the mortality rates for ischaemic heart disease are rising significantly for males aged 55–64 and females aged 45–64. The divergence in trend is particularly noticeable for females aged 45–64. Possible hypotheses are discussed explaining this divergence in trend between two cardiovascular diseases of assumed similar aetiology.

Migraine: definition and classification

There are an enormous number of terms and classifications used in the field of headache and migraine. There is little general agreement and the situation is not helped by the introduction of new terminologies. An approach is suggested to overcome this problem based on the clinical characteristics of the patient. Until there are more definite markers of the different types of headaches, e.g. biochemical, physiological or pharmacological, this should obviate the need for yet further neurological debate.

North West Thames Registry of Neurological Disease

A feasibility study has been carried out to determine whether a population-based registry of neurological disease can be established using the Hospital (Inpatient) Activity Analysis (HAA) records for England and Wales. The study provides a valuable opportunity to use and test the HAA system. The neurological disease chosen was the Guillain-Barré-Strohl syndrome (GBS), because it would be expected that most patients would be admitted to hospital, and recurrent attacks or chronicity are rare. In this study it has been demonstrated that, for GBS, a neurological registry, based on HAA records, provided an excellent source of data to measure the incidence of the disease and potentially any change of incidence over time. The proportion of coding errors was found to be under 5%.

New approach to treatment of recent stroke.

we would like to suggest that at least two factors be taken into consideration. Firstly, because the activity of EFAs is now thought to rest in their conversion to the longer-chain derivatives used for cell membrane and prostaglandin production, the long-chain derivatives themselves ought to be given as part of the nutritional supplement. Secondly, the amounts of non-essential fatty acids given should be controlled because high dietary levels of these fatty acids are known to compete with EFAs for the enzyme systems that give rise to the active longer-chain derivatives.

Experience with High-Dose, Alternate Day Methylprednisolone in Patients with Grade III/IV Astrocytoma and Secondary Cerebral Tumors

Corticosteroids are frequently used as adjuncts in the treatment of patients with malignant brain tumors. Treatment regimes widely differ, especially with respect to corticosteroids. The use of these drugs is influenced by the known side-effects of prolonged administration which include Cushing’s syndrome, sepsis, gastrointestinal hemorrhage, the precipitation of diabetes and myopathy. In patients with malignant or inoperable brain tumors, the potential advantages of corticosteroids in the short term are likely to outweigh their possible disadvantages in the long term since the overall prognosis for malignant brain tumors is so bad. So which corticosteroid should we use, what dosage schedule and for how long?